13109 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i! Is - -------------------------- IV S Permit No. ...1.--�•!••�--- """-""-"" --_--- -- - � APPLICATION FOR SANITATION PERMIT r-.'------'I-- (Complete in.Duplicate) Date Issued ------.-•--- �� r �. _.. I� �� '` - This permit Ex fres 1 Year From Date Issued Application is hereby made-to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. � . AR JOB ADDRESS AND LOCA Q, -�� --- - -------- ----• -- -------------------- 1 s1 N ��^^ --3 930 - --t--- -- ---------------------------- -- ' i �------------------- Phone. f Owners Name -----------------..................... -------------------- x Address------------------------- -------- ; /� !� .. * Phone. / / f !_ v - l° Contractor's Name--------------- --- --------------------------------------- f-••----- .. 'l. -' Motel Other ence.,P.Apartment,House,❑—Commercial ❑ Trailer Court ❑ ❑ �Other ❑ Installation well serve Resid. Number of bedrooms Number of ba#hs _:�. Lot'size - Number of living units: __a i u 1 Water Supply: Public system ❑ Community system ❑ Private (� Depth to Water Table P f+• Character of soil to aidepth�of 3 feet: ,Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C1 Adobe ' Hardpan C1 I No ❑ i; Previous Application Made: 1(lf yes,dote-_`. .__-.- -. - ) No ❑ New Construe#ion: Yes ❑ No [ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND,SPECIFICATIONS: i (No septic tank or cesspool permitFed if 1:;i61ic sewer is available within 200.feet.) T - ,._ . F. Septic Tank: Distance, feom nearest well..�Q�.. ._Diistatice from founoation_�_.-__:__`---.Mate`r�-.�..__________-;=�-:--------••.----- Size---6_X^-3--�- p }Y--- --- •- No. of compartments--'___-- Liquid depth------- 1?.---.----Ca aci ��- •--- Disposal Field: Distance from nearest welL..�D ---_Distance from foundation...p?_Ct.�...a Distance to nearest lot line-----sz..-__--- t �' Number-of lines----- C21 ------ -- Length of each line--- ,E `�-- Width of trench.: �. •�----•-------------- rJ p Type of filter ma#erial._.S.e.�}� .De th of filter niaterial....�g------------Total lengfih..__....f _ ______-------------'- t� .. ._ i epage Pit: Distance to nearest well......................Distance-from foundation_..._'------ r.Disfiance to nearest lot line.........._....._ 01❑ Number of pith--:------------------"Lining°material- `'" __r__ -Size: Diameter-%---- -_Depth----------------------...•------ I p i A _ _ Cesspool: Distant Lining material__�... --- e•from nearest well--------------"._Distance from foundatron w De th fl` ' ... Liquid•Capacity- gals. . ❑ Size: Diameter_ -- --------- -- --' i? �� �.� ::� �� _: ----_ Distance from nearest building_...-..._ - Privy: Distance from nearest-well .-��----- I ¢ y:L „4 ._ I 6 _ f f 1.- a""- '1 r �..�` ----------------- - ,r ❑ Distance to nearest lot Fine-•------------- - - ---------=-----`---•-'------ ----`---------- { 6 ! Remodeli g and/or repairing Idescribe):__.4 -•- `` � -------------------- ----------------- -- ------- --------------- -------------•------------------------------------------------ • - I hereby certify that I have prepared this application and that-tke work-will be done to accordance with San Joaquin County ordinances St ws, and Cul and,rec'I ' ns of +he San Joaquin Local Health District. ...._...... 1 1 (Signed)-- �iL/4 --- --- -- hner and/or Contract � _ w d/o or r (Title).. R-��- ------- =------------------------- of -=--- --- -- ------- (Plot plan, showing size of 10#, o ation�of system inn rel 6_n to rrµells buildings'ldings;etc., can be placed on reverse side]. I •p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......: . ---------------------------------------------- --- DATE------ -----,�- -- � -- - 6 ----------------------- 1!1QATE -------------------------------------------- REVIEWED BY------------------ BUILDING PERMIT ISSUED---------------------------------------------------- DATE Alterations and/or recommendations:.- '__-- / - ------- -----------•-•-- -------""---•----••----•-------------------------------------------------- I --------------------•-- -------------------------------------- - -------------- ---------- -------------------•----- ;- - -------- -- ------ f o Y INSPECTION B -------- FINAL � Date '-- ' :.---- i, SAN JOAQUIN LOCAL HEALTH DISTRICT = 130 South American StreeII t 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E8.9 REVISES 8•B4 F.P,CO.ZM 6-60 I!